MEDICARE: KIMBERLY VASKO CLEVINGER MA, OT/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	132473	KY

General Provider Information

NPI Number	:	1780805895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY VASKO CLEVINGER MA, OT/L

Provider Business Mailing Address
First Line	:	3422 COOPER CREEK RD
Second Line	:
City	:	WOODLAWN
State	:	TN
Zip	:	37191-8132
Country	:	US
Telephone Number	:	502-541-9512
Fax Number	:

Provider Business Practice Location Address
First Line	:	3422 COOPER CREEK RD
Second Line	:
City	:	WOODLAWN
State	:	TN
Zip	:	37191-8132
Country	:	US
Telephone Number	:	502-541-9512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	10/11/2024

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